CLINICIAN-TEACHERS AS TWO-WAY CONNECTORSSupport for brokerage between education and clinical practice in postgraduate medical education
Docent-clinici als verbinders
Opleidingen huisartsgeneeskunde en ouderengeneeskunde willen dat hun docenten ook in de klinische praktijk werken. Deze dubbelrol van een docent-clinicus kent vele uitdagingen en dit draagt er aan bij dat vinden en vasthouden van een goede docent-clinicus lastig is.
Om de dubbele rol van docent-clinici te ondersteunen, is meer begrip nodig over hun verbinding van klinische praktijk en onderwijs. Hoe zorgen docent-clinici dat klinische kennis zijn weg vindt in het onderwijs en hoe brengen zij opleidingskennis naar de praktijk? Ondersteuning voor docent-clinici kan door formeel onderwijs of via informele ondersteuning op de beide werkplekken. Verwacht mag worden dat dit leidt tot beter onderwijs voor artsen in opleiding.
Doel en werkwijze
In dit project gaan we docent-clinici van de opleidingsinstituten in Nijmegen en Utrecht interviewen en observeren. Op basis van wat we leren uit de interviews en de observaties organiseren we focusgroepen om praktische aanbevelingen te formuleren.
Samenvatting van de aanvraag
Background In general practice and elderly care medicine, institutes for postgraduate medical training consider it crucial that teachers also work in clinical practice. Clinician-teachers are pivotal to establish a two-way connection (called brokerage) between two very different socio-cultural contexts: clinical practice and education. Working in both contexts, clinician-teachers introduce the clinical practice perspective in their teaching and apply updated knowledge or teaching skills in their clinical practice. Unknown is to what extent and how brokerage is accomplished and influenced by clinician-teachers’ capabilities, and the contexts in which they operate. Understanding clinician-teachers’ brokerage is relevant from a practical as well as a theoretical point of view. We know that the dual-role for clinician-teachers is challenging, and recruiting and retaining clinician-teachers is not easy. Therefore, insights into ways to strengthen and support the dual-role of clinician-teachers, through education and workplace support, have strong practical relevance. An educational study contributes to these insights. The educational literature identified the complexity of brokerage in a dual-role and described brokerage in terms of boundary crossing at the intrapersonal level between intersecting communities of practice recently called ‘landscapes of practice’. Medical education studies on brokerage at the intrapersonal level are scarce and as such our work has theoretical relevance as well. Aim This study aims to understand clinician-teachers’ brokerage within general practice and elderly care medicine and, based on that understanding, develop recommendations for improvement. The recommendations for improvement concern first workplace support and faculty development within the institutes, which contributes to the quality of trainees’ education, and second arrangements within clinical practice to strengthen and support clinician-teachers in applying updated knowledge or teaching skills in that clinical context. The results will add to the medical education knowledge base on intrapersonal brokerage of dual-role professionals at the boundaries between different landscapes of practice. Method We propose a focussed ethnography study for which to collect rich data on clinician-teachers’ brokerage, contextual conditions, and personal capabilities in three training institutes. A part-time PhD student (an AIOTO) carries out the study dispersed over six years (total time spent on the study is three years effectively). In accordance with the idea of saturation, the number of participants is an informed estimate at this time. Twenty-four clinician-teachers, from general practice and elderly care medicine, are interviewed about their two-way connection between education and clinical practice. We observe six of these clinician-teachers in their clinical and their teaching environment. Also, we interview twelve trainees (two for each clinician-teacher), six behavioural scientists who teach alongside the clinician-teachers, and six clinicians who work in the clinician-teachers’ clinical practice. Transcripts, from audio recordings of interviews, and field notes from the observations are analysed regarding brokerage and what clinician-teachers’ capabilities and contextual conditions affect brokerage. Using the findings of the first three studies, we set up two different series of at least two focus groups with participants from the clinical and the educational landscape of practice separately to co-design recommendations. Dissemination Findings are disseminated in both scientific as well as professional journals, and at events targeting the health professions educational community such as the AMEE (Association for Medical Education in Europe) conference. Within the Netherlands, we have a network of eleven (soon to become twelve) post-graduate training institutes in general practice and elderly care, all of whom employ dual-role professionals and therefore will be able to apply the findings of our study, and also internationally we expect applicability of our results as many postgraduate programmes employ clinician-teachers. Results will directly contribute to the existing national curriculum for clinician-teachers within the post-graduate training institutes, which will improve education for trainees. Also, making the gains of employing dual-role clinician-teachers more explicit, our findings will help to establish strategies for recruiting and retaining clinician-teachers within postgraduate training as well as in clinical practice.